General Info + Tips/Tricks:

General expectations
  • Call: Two calls, one weekday, one weekend
  • Didactics: You present one journal club, 10-15 min presentation
  • Schedule: Expect to get your schedule ~2-4 weeks before starting your rotation. You can request specific calls by emailing the Cornell Chiefs, if need be.
  • Contacts: Mary Hargett is the coordinator for the program
Where are the ORs?
  • There are 3 sets of ORs: 1st floor (Hand and Foot), 4th floor (Main) and 9th floor (Ambulatory).
  • Access the 9th floor only through the West elevators. The 4th floor can be accessed
Where to keep your stuff:
  • There's a locker room associated with each set of ORs. You will not have a locker, but you can hang your coat on many racks here.
  • It's generally accepted to have a bag in the ORs. I've seen attendings bring entire backpacks and coats into the OR as well
  • If you want a safe, non-OR spot, you can put it in the call room on the 4th floor. It's just across from the East Elevators, door code 2+4 then 3.
Where to eat:
  • ~2/3 of attendings will order you delivery for lunch every day.
  • For the 1/3 that don't, you can either go to the Belaire Cafe across the street, buy from the cart lady in the 3rd floor break room (cash only), or snack on PBJs and other free snacks they have in the break areas.

Daily Responsibilities

Your First Day:

  • They'll arrange for a fellow to give you a brief tour and get your Epic access and badge all set up from approximately 6:30AM - 9AM on your first day.
  • Then you'll join an attending and finish out the day working like usual!

Daily Flow

  • ORs start at 8AM usually, but 8:30 on Thurs for grand rounds. Always check your case start the day before--surgeons stagger their two rooms and you'll often be in a later-start room
  • Techs: you will NOT have access to regular techs, but you can ask your circulator to contact the tech if you really need them. The rooms are usually very well stocked in the AM
  • Setup:
    • Most cases are block + sedation.
    • Premedication: most attendings like 5mg versed +/- ketamine or fentanyl. Older patients you can start with 2mg versed
    • Monitors: All of the cords STAY IN THE ROOM at all times, don't take any part of the cables to PACU and embarrass yourself like I did on my first day! EKG leads can be found in the containers on top of the anesthesia cart. Except for the leads, everything is reusable
    • Airway: usually nasal cannula, but there are LMAs and ETTs etc. in the anesthesia machine
    • Blocks: when you preop with your attending, always ask what they want in their blocks. Usually it will be 0.25% bupi + 2mg of PF decadron in a 30cc syringe for each. Connect this syringe to a regular IV extension.
    • Equipment: Bring an ultrasound to the room in the AM (found in the hallway outside the ORs) and program your patient in by ordering 'block ultrasound' in epic, and then it should autopopulate in the patient list in the ultrasound
    • Maintenance: usually propofol infusion. Set this up by using a 60cc syringe with 2 vials of propofol connected to stopcock > spaghetti tubing > another stopcock. The second stopcock will then be connected to the first sideport in the patient's IV. They run infusions in 'mL/h' rather than weight based, and a good starting point is usually 22mL/h
    • Machine: You will have to do your own machine checks
  • Expect to be relieved at 6pm, or whenever your room ends

Common Cases:

  • TKR: Expect to do a single-shot spinal, I-PACK and adductor canal block
  • Hip: ***
  • Shoulder: Usually interscalene vs. superior trunk block, +/- LMA

Call Responsibilities:

We take two calls while at HSS for a month, one weekday and one Saturday.

  • For your weekday, report at 4:30PM to PACU bay 1 to start rounding with the team. Weekday call ends at 8AM, start rounding in the OSCU (5th floor, connected with 'Step Down Unit' which you can follow the signs to)
  • For your weekend, report at ***.

An attending will be in-house with you overnight, but they sleep in the building across the street.

Signing out PACU patients

  • You will be given a phone with an app called 'PerfectServe' on it, which is similar to epic message or CORUS.
  • Every time a patient is ready to be signed out, you'll get a message from that nurse
  • You do not have to see the patient, simply go to the patient in Epic and put in the PACU discharge eval
  • The fastest way to get ahead of these messages is to go to:
    • All Status Boards (upper border menu) > All Areas PACU board > look at the two columns towards the end, Post Note and DC Order. If DC order has a checkmark, and post note has '!!' then the patient is ready for PACU discharge eval to be written.
    • From this board, right click on the patient > Post Signout > Addendum > fill out the note by clicking 'normal patient' > sign, and then your job is done!

Covering patients

  • On Saturday, we cover 3 units: the PACU boarders, the Step-Down Unit (SDU) and the OSCU. On weekdays, we usually just cover SDU + OSCU depending on PA coverage.
  • Only write notes on patients who are new or have significant events.
    • Notes with template can be found by opening the patient's chart by clicking 'rounding' while highlighting the patient > 'rounding' tab > OSCU tab > write in NoteWriter

Top contributors: Olivia Sutton

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